(AP) - Tom, a 39-year-old Boston man, had normal cholesterol and no apparent symptoms before he suffered a heart attack and was rushed to Brigham and Women's Hospital this past weekend.
An average 25 million to 35 million apparently healthy, middle-aged Americans have normal cholesterol, like Tom, but above-average inflammation, putting them at unusual risk of heart attacks and strokes.
But a cheap, simple blood test of the C-reactive protein level could have discovered this before he was stricken.
New data shows the test to be packed with promise.
Researchers from the Framingham Heart Study examined the relationship between levels of C-reactive protein, or CRP, which detects inflammation in the body, and coronary calcium, which indicates the extent of fatty buildup in the arteries, in more than 300 adults.
Inflammation Is Important Risk Factor
Doctors have long known that only about half of all heart attacks can be explained by traditional risk factors such as high cholesterol, high blood pressure, being overweight or lack of exercise.
But in the last two years, researchers say the evidence of inflammation's role has become overwhelming.
"We knew we were missing something," said Dr. Robert Banow, president of the American Heart Association. "And this new concept of inflammation causing heart attacks opens up a whole new way of identifying other individuals who may be at risk."
When inflammation develops in the artery, the fatty deposit weakens and then ruptures, like a pimple. That triggers a blood clot, which blocks the artery and causes the heart attack.
The blood test would detect inflammation long before it could cause damage.
"We used to think of artherosclerosis like sludge clogging up a pipe," said Dr. Peter Libby, chief of cardiovascular medicine at Brigham and Women's Hospital. "And recently we've learned that the artherosclerotic process, which causes hardening of the arteries, is due to inflammation. We can measure in the blood a protein molecule that is sort of like a gas gauge of the overall inflammatory burden."
‘Going to Change Medicine’
Libby believes the test is going to be particularly useful in younger populations, who don't have red flags waving indicating established risk factors.
"Unfortunately, most heart attacks and most strokes happen in people who have average cholesterol and not severely elevated blood pressure," Libby said.
Studies show that once it is detected, inflammation can be treated effectively by drugs commonly used to treat high cholesterol, like Lipitor and Zocor, as well as aspirin, exercise and weight loss.
Tom, who requested that his last name not be published, says he would like his loved ones to undergo the test when it becomes available to prevent this from happening to them.
"If my children are at risk, with a family history of this, I would make sure they would have the test. In hindsight, I think you would do anything to prevent [the heart attack]. But you never think something like this is going to happen to you," he said.
A panel of doctors is considering whether to make the test for C-reactive protein a suggested part of standard medical examinations, like the blood test for prostate cancer. A decision is expected by the fall.
"The C-reactive protein is an exciting topic in research right now," Libby said. "I think it's going to change medicine. I think we're going to go beyond the measurements of cholesterol and blood pressure, and look into the crystal ball of patients whose blood pressure and cholesterol are average."